Pharmacy benefits managers; requirements; scope; report. Requires all health insurance carriers to use the pass-through pricing model and may limit a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier except for income derived from a pharmacy benefits management fee. The bill prohibits a pharmacy benefits manager from (i) reversing and or resubmitting the claim of a pharmacist or pharmacy without meeting certain requirements, (ii) reducing any payment to a pharmacist or pharmacy to an effective rate of reimbursement, or (iii) retroactively denying or reducing a claim or aggregate of claims except under certain circumstances. The bill requires the State Corporation Commission (the Commission) to examine the practice of carriers or pharmacy benefits managers requiring or inducing covered individuals to utilize pharmacy services at an affiliated pharmacy. The Commission is required to report its findings and recommendations to the General Assembly by December 1, 2027. Certain provisions of the bill have a delayed effective date of July 1, 2027. This bill is identical to SB 669.
Health insurance; cost-sharing payments for insulin and diabetes equipment and supplies; limit. Decreases the cap on the cost-sharing payment that a covered person is required to pay for a covered prescription insulin drug from $50 to $35 for a 30-day supply of the prescription insulin drug and provides such cap is an aggregate cap that applies in situations where the covered person is prescribed more than one insulin drug. The bill also establishes such an aggregate cap of $35 for a 30-day supply of diabetes equipment and supplies.
Licensed substance abuse treatment practitioners; licensure by endorsement; licensure without examination. Directs the Board of Counseling to establish a pathway to licensure by endorsement as a licensed substance abuse treatment practitioner for applicants who have held certification as a certified substance abuse counselor for at least 10 years without a history of disciplinary action, have completed at least five years of documented supervised experience, hold at least a master's degree in an appropriate field of counseling, and hold a Master Addiction Counselor credential issued by NAADAC, the Association for Addiction Professionals. The bill provides that such pathway to licensure by endorsement does not require examination.
Commissioner of Health; feasibility of a statewide maternal health safety initiative; work group; reports. Directs the Commissioner of Health to convene a work group of relevant stakeholders, described in the bill, to evaluate the feasibility of a statewide maternal health safety initiative. The bill directs the Commissioner to submit an interim report of the work group by November 1, 2026, and a final report with the work group's recommendations no later than July 1, 2027, to the House Committee on Health and Human Services, the Senate Committee on Education and Health, and the Commission on Women's Health.
Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.
Drug manufacturers; 340B Drug Pricing Program; work group; report. Directs the Secretary of Health and Human Resources to convene a work group to conduct a comprehensive evaluation of the impacts of the federal 340B Drug Pricing Program within the Commonwealth, with emphasis on governance, transparency, and the availability of pharmacy services in rural and underserved areas. The bill requires the work group to submit a report on its findings and recommendations to the Chairs of the Senate Committees on Finance and Appropriations and Education and Health and the House Committees on Appropriations and Health and Human Services by November 1, 2026.
Department of Health; reduction of opioid overdose and opioid overdose deaths; report. Directs the Department of Health to develop a strategic plan for opioid overdose response to reduce rates of drug overdose and drug overdose deaths in the Commonwealth and to provide a report on the status of such strategic plan and its implementation to the Governor, the Chairs of the House Committees on Appropriations and Health and Human Services and the Senate Committees on Education and Health and Finance and Appropriations, and the Joint Commission on Health Care by November 1, 2026, and annually thereafter. As introduced, this bill was a recommendation of the Joint Commission on Health Care. This bill is identical to HB 794.
Active Pharmaceutical Ingredient Manufacturing Grant Fund. Establishes the Active Pharmaceutical Ingredient Manufacturing Grant Fund to provide grant installment awards between July 1, 2026, and July 1, 2045, in an amount not to exceed $15 million per fiscal year and in an aggregate amount not to exceed $130 million, to a qualified company that (i) engages in the manufacture of pharmaceutical substances, (ii) executes a memorandum of understanding with the Commonwealth, and (iii) is expected to make a capital investment of at least $2,148,793,019 and create and maintain at least 468 new full-time jobs. This bill is identical to HB 800.
Comprehensive crisis system; Marcus alert system; Department of Behavioral Health and Developmental Services; comprehensive mental health, substance abuse, and developmental disability crisis services; written plan. Allows the Department of Behavioral Health and Developmental Services, in collaboration with the Department of Criminal Justice Services, to amend the written plan created pursuant to relevant law after the publication of such written plan, provided that (i) the stakeholders listed in relevant law are consulted during the development of any new language to be added to such written plan and (ii) a public comment period of no less than 30 days is held prior to the finalization of such written plan. The bill also provides that the written plan shall serve as the operational framework for relevant components of the comprehensive crisis system and the Marcus alert system and that state agencies and local implementing partners shall align their policies, procedures, and operations on an ongoing basis with the requirements and guidance set forth in the written plan, as amended. As introduced, this bill was a recommendation of the Behavioral Health Commission. This bill is identical to HB 453.
Comprehensive crisis system; Marcus alert system; Department of Behavioral Health and Developmental Services; comprehensive mental health, substance abuse, and developmental disability crisis services; written plan. Allows the Department of Behavioral Health and Developmental Services, in collaboration with the Department of Criminal Justice Services, to amend the written plan created pursuant to relevant law after the publication of such written plan, provided that (i) the stakeholders listed in relevant law are consulted during the development of any new language to be added to such written plan and (ii) a public comment period of no less than 30 days is held prior to the finalization of such written plan. The bill also provides that the written plan shall serve as the operational framework for relevant components of the comprehensive crisis system and the Marcus alert system and that state agencies and local implementing partners shall align their policies, procedures, and operations on an ongoing basis with the requirements and guidance set forth in the written plan, as amended. As introduced, this bill was a recommendation of the Behavioral Health Commission. This bill is identical to SB 513.
